HIV/AIDS in Thailand

Prevalence

After Thailand’s first case of HIV/AIDS was reported in 1984, the incidence of infection increased steadily in the country. In 1991, the government adopted a strategy to combat the disease, and in recent years, the number of new infections has declined. However, HIV prevalence had remained the same from 2003 to 2005 (1.4 percent) with more people receiving antiretroviral therapy (ART).

Thailand’s early cases of HIV/AIDS occurred primarily among men who have sex with men (MSM). The virus then spread rapidly to injecting drug users (IDUs), followed by sex workers and their clients. Between 2003 and 2005, there were increases in HIV prevalence from 17 to 28 percent among MSM in Bangkok. In addition, prevalence among IDUs still ranges from 30 to 50 percent. In 2005, more than 40percent of new infections were among women, the majority of whom were infected through intercourse with long-term partners. Violence and a low level of condom use due to women’s inability to negotiate safe sex are factors responsible for the spread of HIV among this group. Although the prevalence of HIV/AIDS in Thailand has declined, the epidemic has moved to the general population, and there is a greater need to match prevention efforts with recent changes in the epidemic.

Several factors put Thailand at risk of a resurgence of HIV/AIDS cases. Awareness of HIV status is low. For example, 80 percent of HIV-positive MSM had never been tested or thought they were HIV-negative, according to a 2006 study cited by UNAIDS. A large portion of IDUs – 35 percent according to one study – use nonsterile injecting equipment. Other research has noted an increased trend of erratic condom use by female sex workers. In some cases, women selling sex reported using a condom in just over one half of commercial sex encounters. Finally, premarital sex, once taboo, is increasingly common among young Thais, only 20 to 30 percent of whom use condoms consistently, according to the United Nations Development Program.

Thailand has a high tuberculosis (TB) burden, with a 63 new cases per 100,000 people in 2005, according to the World Health Organization. Approximately 7.6 percent of TB patients are co-infected with HIV, and HIV-TB co-infections pose a challenge to providing treatment and care for both diseases. [http://www.usaid.gov/our_work/global_health/aids/Countries/ane/thailand_profile.pdf "Health Profile: Thailand"] . United States Agency for International Development (March 2008). Accessed August 25, 2008. PD-notice]

National response

Thailand’s initial response to the epidemic was weak. However, since the National AIDS Control Program was moved from the Ministry of Public Health to the Office of the Prime Minister in 1991, the country’s HIV/AIDS prevention efforts have been recognized as among the world’s most successful. The Ninth National Economic and Social Development Plan (2002–2006) emphasized the adoption of a human-centered approach to bring about reform through the public health system, especially the health care system. Thailand’s policy on AIDS has worked toward educating its citizens on HIV/AIDS and prevention measures; developing a system of medical, public health, social, and consultation services to improve the quality of life of persons living with HIV/AIDS (PLWHA); developing medical biotechnology, medicine, and AIDS vaccination research; and working with all parties involved, such as the government and private sector, to prevent and alleviate the HIV/AIDS situation.

Thailand’s HIV/AIDS activities include conducting a public education campaign targeting the general public and most-at-risk populations (MARPs), improving sexually transmitted infection (STI) treatment, discouraging men from visiting sex workers, promoting condom use, and requiring sex workers to receive monthly STI tests and carry records of the test results.

In 2004, Thailand received a third-round grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria to prevent HIV/AIDS among IDUs and increase care and support for them. Objectives of the grant are to train peer leaders within IDU communities; create harm-reduction centers; educate health care providers, police, prison staff, and policymakers; and provide peer-based outreach, education, counseling, referral services, and HIV testing support. The U.S. Government provides one-third of the Global Fund’s contributions.

Since the change of government in 2006, Thailand has reinvigorated its HIV/AIDS prevention and control efforts. In 2007, Thailand adopted a three-year strategic plan that focuses on scaling up HIV prevention efforts, particularly for people most likely to be exposed to HIV and for difficult-to-reach populations. Early in 2007, the government announced that it was breaking patents on drugs to treat HIV. Thus, the government continues to strive for achieving universal access to treatment. As of the end of 2006, 88 percent of HIV-infected people were receiving ART, according to UNAIDS.

References